| Acquired perforating dermatosis
(Kyrle’s disease)
(Acquired reactive perforating collagenosis) | | Intensely pruritic umbilicated papules with keratinous plugs involving extensor limbs, less common on trunk/face, + Köebner phenomenon | | Cup-shaped invagination of epidermis with hyperkeratotic plug containing inflammatory debris and collagen fibers, vertically oriented collagen extruded into plug (in dermis) | | Diabetes or renal failure (many patients on hemodialysis), some cases related to malignancy |
| Inherited reactive
perforating collagenosis | | Similar lesions but occur in childhood | | Similar histology to acquired form | | None |
| Elastosis perforans
serpiginosa (EPS) | | Skin-colored to red papules in serpiginous, linear or arciform pattern over upper extremities or neck, may measure several centimers in diameter | | ↑↑ Amount of elastic fibers in papillary dermis appearing clumped and ‘clutched’ by epidermis (hyperplastic); elastic fibers and inflammatory cells extruded via granulomatous reaction | | Associated with:
{MADD PORES:Marfan’s, Acrogeria, Down syndrome,
D-Penicillamine, Pseudoxanthoma elasticum, Osteogenesis imperfecta, Rothmund-Thomson, Ehlers Danlos, Scleroderma} |
| Perforating folliculitis | | Keratotic follicular papules commonly over extensor surfaces | | Involved hair follicle shows disruption of lateral wall; parakeratotic plug consists of collagen, elastic fibers and inflammatory cells | | Chronic renal failure and diabetes |
| Perforating
periumbilical calcific
elastosis | | Keratotic papules involving the abdomen | | Transepidermal elimination of calcified elastic fibers | | African-American women,
multiparity |
